Peace and Conflict Studies - Spring 2014

Peace and Conflict Studies Volume 21, Number 1 51 mediation, negotiation, and cross-cultural training (hereinafter, CCT) as a way to engage with end-of-life conflict. I have chosen end-of-life care because it is a stage in which cultural beliefs, from patients and providers, are more palpable and prone to clash (Krakauer, Crenner & Fox, 2002). In addition, throughout the dying process, structural and cultural violence become ubiquitous. Moreover, death is a universal phenomenon and how we die is intrinsically related to how we live. I also focus the discussion on clinician/physician’s role in end-of-life care to narrow the scope of this article. I begin by discussing end-of-life care disparities. I then discuss structural and cultural violence in end-of-life care and how it is institutionalized in ways that sustain end-of-life care disparity. I conclude by showing how CCT training has been ineffective in addressing disparate end-of-life care and that conflict engagement practitioners have the necessary skills to facilitate structural interventions in acute healthcare facilities that may rearrange power structures and lessen unequal end-of-life care. Health Disparities and the Dying Patient The manner in which dying patients continue to be invisible in many acute healthcare settings in the United States and are victims of healthcare inequalities is unconscionable. The dying patients in acute healthcare settings are either “minimized” or “swept beyond view into palliative care” because they do not fall within the norm of saving lives (Chapple, 2010, p. 27). Palliative care aims at alleviating pain and relieving symptoms. Since many physicians/clinicians see palliative care as inconsistent with saving lives, they have the misconception that this type of care should only take place once all rescuing attempts have been exhausted (Chapple, 2010). As I will illustrate in this article, worse than being a dying patient, is being a dying patient who is perceived by medical personnel as belonging to a “different” culture, race, or ethnicity. Evidence points to the fact that minority patients are not benefiting from the efforts that have been undertaken to improve end-of life care (Krakauer, et al., 2002). These “different” dying patients become unintelligible. In Butler’s (2004) words, you are unintelligible when the laws of culture and of language find you to be an impossibility [you have no] access to the human, [you] find that your language is hollow, that no recognition is forthcoming because the norms by which recognition takes place are not in your favor. (p.30) There is bountiful empirical evidence that African Americans and other racial and ethnic minorities receive lower quality of healthcare than whites, even when taking into